Irrational use of antibiotics and clinical outcomes in children with pneumonia
Abstract: Pneumonia is a major
cause of morbidity and mortality in children under five. Antibiotic treatment
must be started immediately in children with pneumonia. The irrational use of
antibiotics may increase morbidity and mortality in children with pneumonia.
Obejctive To determine the prevalence of the irrational use of
antibiotics and clinical outcomes in children with pneumonia.
Methods We conducted a cross-sectional study in children with pneumonia
who were admitted to the Pediatric Ward or PICU at Dr. Sardjito Hospital,
Yogyakarta, from December 2010 to February 2013. Data were obtained from
subjects’ medical records. Children with malnutrition, congenital heart
defects, sepsis, shock, central nervous system disorders, syndromes, or other
concomitant infections were excluded.
Results Of 46 children who fulfilled the inclusion criteria, 13 (28.3%)
used antibiotics irrationally and 7 (15.2%) died. Most subjects were aged less
than 1 year (25 subjects, 54.3%) and 1 - < 5 years (18 subjects, 39.1%). The
female to male ratio was 1:1. Most cases were referred from other hospitals (23
subjects, 50%). Twenty-eight (60.9%) subjects stayed in hospital > 7 days.
Ampicillin was the most common first-line, empirical antibiotic used (32
subjects, 69.6%). Blood cultures were obtained in 20 (43.5%) patients, yielding
no growth in 16 subjects, coagulase-negative staphylococci (CONS) in 3
subjects, and Pseudomonas aeruginosa in 1 subject. The irrational use of
antibiotics was significantly associated with mortality in a univariate
analysis [PR 6.35; (95%CI 1.40 to 28.69); P=0.006].
Conclusion The irrational use of antibiotics is common among children
with pneumonia and is significantly associated with mortality.
Keywords: antibiotic;
irrational; pneumonia; children
Author: Yusuf, Indah Kartika
Murni, Amalia Setyati
Journal Code: jpkedokterangg170140
